| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $53.95 | $53.95 | $53.95 | |
Aetna
| Professional | $53.95 | $53.95 | $63.22 | |
Cigna
| Professional | $53.95 | $53.95 | $53.95 | |
Kaiser Permanente
| Professional | $29.64 | $34.40 | $44.46 | |
United
| Professional | $52.89 | $52.89 | $63.47 |